Hospital-acquired delirium occurs in more than 50% of postoperative older adults and is costly, in terms of dollars and adverse outcomes, including increased morbidity and mortality. In addition, delirium is under-diagnosed and not recognized by nurses up to 85 percent of the time, therefore, interventions are needed at the point of care to assist nurses in recognizing delirium. The goal of screening for delirium is to enable nurses to identify delirium early and intervene with evidence-based care strategies to enhance patient safety and minimize adverse events including falls, restraint use, pressure ulcers, and urinary tract infection. The health care costs associated with delirium are considerable. In the last decade, the estimated annual inpatient hospital costs due to delirium alone and its complications have doubled, from $4 billion to $8 billion. Costs for home care, rehabilitation, and nursing home care for patients with delirium are incurred beyond the acute care costs. This study will employ a pre-post design with older adult patients undergoing elective hip and knee surgery The study's aims are to: 1) establish the feasibility of incorporating the Confusion Assessment Method (CAM), screening tool for delirium, with score alert system into a hospital-based electronic medical record and evaluate the facilitators and barriers to full integration; 2) assess the effect of screening with the Confusion Assessment Method (CAM) on nurses' ability to recognize and identify incident delirium and severity of delirium; 3) determine the effect of screening with the Confusion Assessment Method (CAM) on the number of evidence-based management strategies implemented by nurses; and 4) determine the effect of screening with the Confusion Assessment Method on clinically recognized adverse events including falls, pressure ulcers, urinary tract infections, restraint use in postoperative older adults undergoing hip and knee surgery. The proposed study is consistent with AHRQ's broad based goal "enhancing quality and safety by reducing risk of harm from health care services through promoting the delivery of appropriate care that achieves the best quality outcomes" and addresses one of AHRQ's current priority areas "translating research into practice by testing strategies for adoption, implementation, and routinization of evidence-based clinical and organization intervention." This research is consistent with Healthy People 2010 Goal 1 to increase life expectancy and quality of life for older adults through focusing on mental health and mental disorders. A public health commitment to quality of care and improving outcomes in this known vulnerable population holds the potential to reduce immediate adverse events and long-term morbidity, and mortality, as well as reduce health care resource consumption in older adults who experience an episode of postoperative delirium. [unreadable] [unreadable] [unreadable]